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目的:研究珂立苏(肺表面活性物质)联合经鼻间歇性正压通气(NIPPV)治疗新生儿呼吸窘迫综合征(NRDS)的临床效果。方法:选取2010年4月-2012年4月我院NICU收治的符合NRDS诊断标准的患儿46例,将患儿随机分为试验组29例和对照组17例。试验组患儿给予珂立苏联合NIPPV治疗,对照组患儿仅给予NIPPV治疗。比较两者患儿治疗前及治疗后6h、24h、48h呼吸功能参数变化情况、X线胸片评分改变情况及3d内存活率。结果:⑴呼吸功能参数情况:试验组患儿上机时(用药前)及用药后6h、24h、48h后肺顺应性(C值)随通气时间进展而逐渐升高,氧合指数(OI值)、呼吸指数(RI值)及肺泡-动脉氧分压差((A-a)DO2值)均随通气时间进展而逐渐下降。试验组患儿经珂立苏治疗后6h、24h、48h和对照组比较,C值均显著高于对照组(P<0.01),OI值均显著低于对照组(P<0.01),RI值均显著低于对照组(P<0.01),(A-a)DO2值均显著低于对照组(A-a)DO2值。⑵X线胸片变化:试验组患儿上机时(用药前)及用药后6h、24h、48h后X线胸片评分逐渐降低,且用药后6h、24h、48h后每一时间点评分均显著低于对照组(P<0.05)。⑶患儿3d内存活率:试验组患儿存活率96.4%显著高于对照组70.1%(P<0.05)。结论:肺表面活性物质(珂立苏)联合经鼻间歇性正压通气(NIPPV)能明显改善患儿肺通气、换气功能,降低患儿死亡率,治疗新生儿呼吸窘迫综合征临床疗效显著优于单纯应用NIPPV治疗。
Objective: To investigate the clinical effect of Ke Li Su (pulmonary surfactant) combined with nasal intermittent positive pressure ventilation (NIPPV) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods: From April 2010 to April 2012, 46 children with NICDS who met the NRDS criteria were selected and randomly divided into experimental group (n = 29) and control group (n = 17). The children in the experimental group were treated with Coriolis combined with NIPPV, while those in the control group were treated with NIPPV only. The changes of respiration function parameters, the change of X-ray and the survival rate of 3d in 6h, 24h and 48h after treatment were compared between the two groups. Results: (1) Parameters of respiratory function: The lung compliance (C value) of the experimental group increased gradually with the ventilation time on the machine (before treatment) and 6h, 24h and 48h after treatment. The oxygenation index ), Respiration index (RI) and alveolar-arterial partial pressure of oxygen ((Aa) DO2) decreased gradually with the progress of ventilation time. The C values in the experimental group were significantly higher than those in the control group at 6h, 24h and 48h (P <0.01), and the OI values in the experimental group were significantly lower than those in the control group (P <0.01) (P <0.01), (Aa) DO2 values were significantly lower than the control group (Aa) DO2 values. X-ray changes in chest X-ray: the test group children on the machine (before treatment) and 6h, 24h, 48h after treatment X-ray score decreased gradually, and after 6h, 24h, 48h after treatment, each time points were significantly Lower than the control group (P <0.05). (3) The survival rate of 3d in children: The survival rate in experimental group was significantly higher than that in control group (96.4% vs 70.1%, P <0.05). CONCLUSIONS: Pulmonary surfactant (Ke Li Su) combined with nasal intermittent positive pressure ventilation (NIPPV) can significantly improve children’s pulmonary ventilation and ventilatory function, reduce the mortality rate of children, and treatment of neonatal respiratory distress syndrome has a significant clinical effect Superior to the simple application of NIPPV treatment.